DIAGNOSTIC CHALLENGES. CASE REPORT: DEADLY TRIAD OF TUBERCULOSIS, ASPERGILLOSIS AND SQUAMOUS CELL CARCINOMA OF THE LUNG

Abstract

Pulmonary tuberculosis remains a prevalent disease in Latin America and can coexist with other serious respiratory conditions, including lung cancer and opportunistic fungal infections. The overlap of these entities poses a diagnostic and therapeutic challenge, especially in patients with constitutional symptoms and hemoptysis. We present the case of a 62-year-old man with a three-month history of cough, hemoptysis, fever, night sweats, and weight loss. Chest computed tomography scan revealed an irregular mass of 4.2 × 6 cm in the right upper lobe with mediastinal lymphadenopathy. Bronchoscopy revealed friable, bleeding, exophytic endobronchial lesions that hindered visualization of segments I and II. Bronchoalveolar lavage detected Mycobacterium tuberculosis by Xpert MTB/RIF assay with high bacterial load and no rifampicin resistance. Cytological and histological studies confirmed squamous cell carcinoma of the lung. During the course of the illness, pulmonary cavitation was observed with imaging findings suggestive of as-
pergilloma, confirmed by Aspergillus spp. using galactomannan in bronchoalveolar lavage. Despite the initiated antituberculous and antifungal  treatment, the patient experienced tumor progression and died three months after the initial diagnosis. This case illustrates the diagnostic challenges posed by coexisting tuberculosis, lung cancer, and pulmonary aspergillosis, underscoring the need to consider concomitant diagnoses in cases of atypical clinical presentation.